International Journal of Endocrinology and Metabolism
Volume:14 Issue: 1, Jan 2016

Under normal physiological conditions, leptin regulates body weight by creating a balance between food intake and energy expenditure. However, in obesity, serum leptin levels increase and become defective to retain energy balance. Elevated serum leptin levels are regarded as an established marker of obesity. It is also reported that obese asthmatic patients have maximum serum leptin levels compared to other groups such as non-obese asthmatics, and normal obese and non obese subjects without asthma. In addition to having an appetite suppressing effect, leptin also regulates certain acute-phase protein expressions including α-1 antitrypsin (A1AT) in the liver. A1AT is a protease inhibitor that counterbalances the activity of the neutrophil elastase (NE) enzyme. A1AT reductions in obese-leptin resistant subjects lead to increased NE activity. The overactivity of NE degrades lung tissue proteins, which may lead to pulmonary disorders including asthma. On the basis of prior studies, it could be hypothesized that, in obese asthmatic patients, the highest degree of leptin failure/resistance might lead to the creation of an imbalance between NE and its inhibitor A1AT. To ascertain this, large scale prospective studies are warranted to assess the comparative serum leptin and A1AT levels and NE activity in asthmatic non-obese and obese patients, simultaneously. Such studies might help to devise novel interventional therapies for the treatment of pulmonary-related problems including asthma, chronic obstructive pulmonary disorder (COPD), and other lung defects in susceptible obese subjects in the future.

Maternal thyroid disease in pregnancy is associated with adverse impact on both mother and fetus. Both the American thyroid association and the endocrine society have recently published guidelines for the management of thyroid disease in pregnancy.. The objective of this survey was to assess and compare the current practices of various East-Asian physicians in the screening and management of thyroid disease in pregnancy.. Completed survey questionnaires were collected from 112 physicians of six East-Asian countries. The survey was based on clinical case scenarios, asking questions about the clinical practices related to diagnosis and management of thyroid disease during pregnancy. Reponses from 76 endocrinologists and 33 internists and general practitioners (generalists) were analyzed.. There were minor differences in treatment preferences for Graves’ disease in pregnancy and tests to monitor antithyroid drugs between endocrinologists and generalists; the major difference being targeted free thyroxin, and also thyroxin, depicted in the upper end of normal range, by the majority of endocrinologist and within the normal range, by generalists. Compared to generalists, endocrinologists perform more targeted screening and are more familiar with its risk factors. Predominantly, endocrinologists increase levothyroxine dose in hypothyroid women, upon confirmation of pregnancy and also indicate full dose in a pregnant woman, diagnosed with overt hypothyroidism, and treat thyroid peroxidase antibody positive or negative pregnant women with thyroid stimulating hormone (2.5 - 5 mU/L), as compared to generalists.. There is wide variation in the clinical practices of screening and management of thyroid disorders during pregnancy in East-Asia, with many clinicians, in particular general practitioners, not adhering to clinical practice guidelines, unfortunately..

Thyroid hormones play an important role in lipid metabolism. Overt hypothyroidism is known to be associated with increased lipid profiles, but the effect of subclinical hypothyroidism (SCH) on lipid profile remains controversial.. The aim of this study was to assess the association between thyroid disorders and serum lipid levels.. The present study was conducted within the framework of Tehran lipid and glucose study (TLGS). Serum concentrations of TSH and FT4, cholesterol, triglycerides and HDL-C were measured in 5786 randomly selected subjects. Serum LDL was calculated according to the Friedwald formula.. The study assessed 5154 subjects including 42.5% males and 57.5% females, with a mean age of 39.71 ± 14.2 years (ranged 20 - 90 years). Serum cholesterol was significantly higher in overt hypothyroidism in comparison to subclinical hypothyroidism (P = 0.003). Serum cholesterol, HDL –C, LDL-C and TG did not differ between subclinical hypothyroid and control groups. Among euthyroid men, serum FT4 levels were inversely correlated with serum cholesterol and TG. In euthyroid women, serum FT4 levels were correlated positively with serum HDL-C and negatively correlated with TG and TG/HDL-C ratio and TSH levels were associated negatively with, HDL-C.. No differences existed in lipid profiles between subclinical hypothyroidism and euthyroid subjects. There are correlations between serum FT4 and TSH and lipid profiles..

Many studies have shown various results regarding the effects of Ramadan fasting on weight and body composition in healthy individuals. This study aimed to evaluate the effect of Ramadan fasting on body composition in healthy Indonesian medical staff.. In this study, we examined the influence of Ramadan fasting on body composition in healthy medical staff..Patients and The longitudinal study was performed during and after Ramadan fasting in 2013 (August to October). Fourty-three medical staff members (physicians, nurses and nutritionists) at the Internal Medicine Ward of the Dr. Cipto Mangunkusumo General Hospital were measured to compare their calorie intake, weight, body mass index, waist-to-hip ratio (WHR), and body composition, including body fat, protein, minerals and water, on the first and 28th days of Ramadan and also 4-5 weeks after Ramadan fasting. Measurements were obtained for all 43 subjects on the 28th day of Ramadan, but they were obtained for only 25 subjects 4 - 5 weeks after Ramadan.. By the 28th day of Ramadan, it was found that the body weight, BMI, body fat, water and mineral measures had decreased significantly (-0.874 ± 0.859 kg, P < 0.001; -0.36 ± 0.371 kg/m2, P < 0.001; -0.484 ± 0.597 kg, P < 0.001; -0.293 ± 0.486 kg, P = 0.001; -0.054 ± 0.059 kg, P < 0.001, respectively). Protein body mass and calorie intake did not significantly change (-0.049 ± 0.170 kg, P = 0.561; 12.94 ± 760.608 Kcal, P = 0.082 respectively). By 4 - 5 weeks after Ramadan, body weight and composition had returned to the same levels as on the first day of Ramadan.. Ramadan fasting resulted in weight loss even it was only a temporary effect, as the weight was quickly regained within one month after fasting. The catabolism catabolic state, which is related to protein loss, was not triggered during Ramadan fasting. Further research is needed to evaluate the effects of weight loss during Ramadan fasting in healthy individuals..

Thyroid dysfunction is the second most common endocrine disease in women of reproductive age. Controversial data on the adverse effect of subclinical thyroid dysfunctions and adverse feto-maternal outcomes.. This study aims to identify the prevalence of thyroid dysfunction during pregnancy and to assess the effectiveness of treatment with levothyroxine on pregnancy outcomes in Tehranian women with thyroid autoimmunity with or without subclinical thyroid dysfunction..Patients and This study encompasses two phases: 1- A population based cross sectional study using a cluster sampling method that screens first trimester pregnant women for thyroid disorders, 2- A double-blind randomized clinical trial to determine the effectiveness of levothyroxine on adverse pregnancy outcomes in women with thyroid autoimmunity with or without subclinical thyroid dysfunction. Pregnant women will be assessed at their first prenatal visit for serum TSH, T4, T-uptake, TPOAb and urinary iodine following which they will be classified as: 1- Normal, 2- Subclinical TPOAb negative and 3- Subclinical/euthyroid TPOAb positive. Women in groups two and three will be randomly divided into two groups: Group A will be treated with levothyroxine (LT4), and group B will not receive any treatment. All study participants will be followed and rates of adverse pregnancy outcomes in the treated and untreated groups will be measured.. Results of the study will provide reliable information regarding the prevalence of thyroid dysfunction among Tehranian women using universal thyroid screening, along with identification of the iodine status of their community. We aim to determine whether LT4 treatment exerts beneficial effects in women without overt thyroid dysfunction..

Prediction is a fundamental part of prevention of cardiovascular diseases (CVD). The development of prediction algorithms based on the multivariate regression models loomed several decades ago. Parallel with predictive models development, biomarker researches emerged in an impressively great scale. The key question is how best to assess and quantify the improvement in risk prediction offered by new biomarkers or more basically how to assess the performance of a risk prediction model. Discrimination, calibration, and added predictive value have been recently suggested to be used while comparing the predictive performances of the predictive models’ with and without novel biomarkers.. Lack of user-friendly statistical software has restricted implementation of novel model assessment methods while examining novel biomarkers. We intended, thus, to develop a user-friendly software that could be used by researchers with few programming skills.. We have written a Stata command that is intended to help researchers obtain cut point-free and cut point-based net reclassification improvement index and (NRI) and relative and absolute Integrated discriminatory improvement index (IDI) for logistic-based regression analyses.We applied the commands to a real data on women participating the Tehran lipid and glucose study (TLGS) to examine if information of a family history of premature CVD, waist circumference, and fasting plasma glucose can improve predictive performance of the Framingham’s “general CVD risk” algorithm.. The command is addpred for logistic regression models.. The Stata package provided herein can encourage the use of novel methods in examining predictive capacity of ever-emerging plethora of novel biomarkers..

The health benefits of pomegranate juice have been reported in several studies. However, limited clinical trials have examined the effects of concentrated pomegranate juice (CPJ) on inflammatory factors.. This study aimed to investigate the effects of CPJ on metabolic risk factors, including inflammatory biomarkers, in patients with type 2 diabetes mellitus..Patients and In a quasi-experiment trial, 40 type 2 diabetic patients were asked to consume 50 g of CPJ daily for 4 weeks. Anthropometric indices, dietary intake, blood pressure measurements, and fasting blood samples were conducted at baseline and 4 weeks after the intervention.. The intake of CPJ produced a significant increase in both total and high-density lipoprotein cholesterol (HDL-C) (4.7% and 3.9%, respectively) from baseline (P < 0.05). However, changes that were observed in serum triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), fasting blood glucose, and blood pressure were not statistically significant. Administration of CPJ caused significant reduction in serum interleukin-6 (IL-6) (P < 0.05), but tumor necrosis factor-α (TNF-α) and high-sensitivity C-reactive protein (hs-CRP) remained unchanged during the study. The mean value of serum total antioxidant capacity (TAC) was substantially increased (~ 75%) from 381.88 ± 114.4 at baseline to 1501 ± 817 after 4 weeks of CPJ consumption.. Consumption of CPJ (50 g/day) appears to have favorable effects on some markers of subclinical inflammation, and to increase plasma concentrations of antioxidants in patients with type 2 diabetes..

Diabetes is a metabolic disorder caused by oxidative stress and inflammation. JianYuTangKang (JYTK), as a potential Chinese integrative medicine, is an antioxidant used in Chinese medicine with potential anti-inflammatory properties.. The present randomized clinical trial was carried out to evaluate the effects of JYTK on oxidative stress and inflammation in patients with type 2 diabetes mellitus (T2DM)..Patients and The parallel, randomized, double-blinded, placebo-controlled clinical trial included 150 newly diagnosed T2DM patients receiving metformin treatment (1.5 g/day), some of whom also received JYTK (4.5 g/day) in tablet form. The control group received 4.5 g/day placebo plus 1.5 g/day metformin. Body mass index (BMI), fasting plasma glucose, urinary albumin-to-creatinine ratio, and complete blood count as well as antioxidant and inflammation indices such as tumor necrosis factor (TNF)-α, interleukin (IL)-6, superoxide dismutase (SOD), malonaldehyde (MDA), glutathione peroxidase (GPX), and high sensitivity C-reactive protein (hs-CRP) levels were assessed at baseline and at different time points during the treatment.. All 112 patients, including 59 in the treatment group (JYTK + metformin) and 52 controls (metformin only) completed the 26-week clinical trial. JYKT plus metformin treatment increased IL-6 (36.4 ± 11.5 ng/L; P < 0.05), TNF-α (17.5 ± 11.3 vs. 22.5 ± 12.9 ng/L; P < 0.05), and MDA (1.9 ± 0.9; P < 0.05) levels compared to the control (2.2 ± 0.6 mM/mL), whereas total SOD level decreased (98.1 ± 30.4 vs. 78.5 ± 29.3 U/mL; P < 0.05). There were no changes in GPX and hs-CRP levels. There were no adverse effects associated with JYTK treatment.. JYTK combined with metformin improves some antioxidant indices (SOD and MDA), and decreases inflammation in patients with T2DM, suggesting that it can reduce the risk of diabetic complications..

Walnut hydrosol (WH) is used extensively by Iranian diabetic people in order to control blood sugar (BS). There are few data about its effectiveness and safety.. A pilot study to determine the efficacy and safety of WH in type 1 diabetic patients..Patients and Eight patients with type 1 Diabetes (DM) were enrolled. They did not use any medicine except insulin. They were advised to drink 250 mL WH after meals twice a day for 4 weeks. They measured their blood sugar (BS) and changed their insulin dose according to their BS. After 4 weeks, they discontinued WH use and checked their BS again for 2 weeks. Finally, we used descriptive statistics for analysis of the data. Also, the essential oil of the sample was extracted using a liquid extractor and then analysis of the constituents was performed.. Seven patients had a decrease in average daily BS and insulin dose. 2 patients developed generalized pruritic erythematous skin rash. One patient presented with hypoglycemic coma. She had not any other risk factor of coma. Seven compounds were identified in the oil and the percentage of mono terpenoid and sesqui terpenoid hydrocarbons were 53.45% and 5.95%, respectively. The main constituents of the oil were carvacrol (33.21%), thymol (16%), and homoveratrole (15.83%).. WH may improve the glycemic control in diabetic people, but it may be associated with minor and major side effects. Further in vitro studies using these seven compounds are recommended to be performed to determine the efficacy and complications of WH in diabetic people..